Childcare as a barrier to healthcare access: A Scoping Review

Context: Health systems are increasingly recognizing the importance of social determinants of health (SDOH) in access to healthcare. Childcare for primary caregivers of children remains understudied as an SDOH. A gap remains in synthesizing existing evidence of unmet childcare needs as a barrier to healthcare access.

Objective: This scoping review provides an overview of how childcare has been examined as a barrier to healthcare access.

Study Design: A literature search for childcare as a SDOH was conducted. Two independent reviewers reviewed results to determine inclusions and exclusions. Included papers were sorted into emerging themes.

Setting: Searches were conducted across PubMed, Scopus, professional healthcare societies, and health policy fora.

Population Studied: The study population is primary caregivers of children.

Instrument: The search strategy included terms describing social determinant of health, healthcare access, and childcare. Studies examining the role of childcare in pediatric health outcomes, mental or physical burden on caregivers, caregiver economics, and topics unrelated to healthcare access were excluded to focus scope to barriers to healthcare access.

Outcome Measures: Included articles were sorted into the following themes pertaining to unmet childcare needs: medical services access, research participation barriers and facilitators, pandemic stressors, and alternative healthcare delivery models.

Results: From an initial yield of 545 results, 85 articles were included. Of the 62 articles that identified childcare as a barrier to utilizing healthcare services, 33 focused on childcare as a discrete barrier and 29 grouped childcare with other logistical barriers. 4 provided childcare to facilitate healthcare access, and 12 concerned alternative models of healthcare delivery (e.g., telehealth, self-screening) to circumvent this barrier. 6 identified childcare as a barrier to research participation, and 4 provided childcare to facilitate research participation. 8 explored the impact of COVID on childcare needs.

Conclusions: Childcare needs remain underexplored in existing research. Current literature discusses childcare as a barrier to healthcare engagement, often grouped with other logistic barriers, and in the context of alternative care delivery models. Future research is needed to understand mechanisms of unmet childcare needs in healthcare access and downstream clinical outcomes.